Dr. Marc R. Matthews of Phoenix and Dr. Jeffrey P. Salomone of Atlanta, for example, say that emergency medical transports could have been used instead of the helicopters in a number of instances.

“I’m all for heroes—for the firefighters who climbed up the stairs while the World Trade Center was falling down or anyone else who risks their life to help people,” Salomone said. “But it’s a real tragedy to think someone could die trying to help a patient who didn’t have a life-threatening injury to begin with.”

In its review of documents associated with the 26 deadly medevac crashes in the United States since 2003, the Baltimore Sun claims that the helicopters were sometimes used in situations that were not immediate or life-threatening. “At least eight involved patients who waited longer for a helicopter than a ground ambulance might have needed to drive them to a hospital. And at least six were for patients discharged soon after a helicopter dropped them off at a hospital, or who survived a lengthy ambulance ride after the helicopter sent to get them went down,” according to the Sun.

Maryland’s program has been under close watch recently. In September a whistleblower warned federal authorities that mismanagement in the program could lead to adverse consequences. Another individual said the helicopter in the Sept. 28 accident had been damaged in an incident years earlier, according to The Examiner.

In 2005, USA Today reported that “a deadly trend of pilot errors, industry carelessness and poor government oversight has driven the number of air ambulance crashes to record levels.” A 2006 reported indicated that 29 of 55 air ambulance crashes between January 2002 and January 2005 could have been prevented.

The National Transportation Safety Board has noted some recurring themes in medical helicopter crashes, including inconsistent dispatch procedures and limited requirements to use “safety-enhancement technologies” like night vision goggles, according to CNN. The NTSB can make safety recommendations for the medical flight industry, but only the FAA can make them mandatory.

On Aug. 31, 2008, an Air Evac medical transport helicopter crashed in Indiana, instantly killing the three crew members on board. This was the fifth accident involving an Air Evac helicopter in recent years.

The crew wasn’t on an ambulance run, but was traveling to a tractor pull event. It’s common practice, Air Evac told the Indianapolis Star, for its workers to attend community events.

NTSB member Deborah A. P. Hersman, told the Baltimore Sun that medical flights are some of the riskiest for helicopters perform. In the last year, Hersman said the NTSB has investigated eight deadly medical flight accidents. "We are very concerned about this segment of the industry, and that's why we sent a whole team" to Maryland, Hersman explained.

Transporting patients in ambulances is not without its potential dangers, either. The Associated Press reports that a recent ambulance crash in Vermont highlighted two concerns common to many such accidents: risky driving and hazardous patient compartments. Dan Manz, head of emergency medical services at the Vermont Department of Health, said the practice of using a “lead foot” to save lives isn’t necessary. The patient compartment problem is a littler harder to address, however. Manz said, “There is heavy equipment in use that is very difficult to secure.”

In Australia, ambulance crews are experiencing such serious cases of fatigue that the Ambulance Employees Australia (AEA) union said the lives of paramedics and patients are at risk. Some workers put in between five and eight hours of overtime a week, and request from 13.5 to 16 sick leave days a year. Those numbers indicate that paramedics are overworked and in need of longer breaks between shifts, the AEA told The Australian. Some workers had admitted to falling asleep at the wheel, and to drawing up and nearly administering the wrong drugs to patients.